scholarly journals SUN-924 Functioning Abdominal Paraganglioma Presenting as Acute ST-Elevation Myocardial Infarction

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jaruwan Kongkit ◽  
Meythee Leelaprute ◽  
Natnicha Houngngam ◽  
Thiti Snabboon
Keyword(s):  
Myocardial Infarction ◽  
Imaging Study ◽  
Celiac Trunk ◽  
Signs And Symptoms ◽  
Inferior Wall ◽  
Unusual Manifestation ◽  
Coronary Syndrome ◽  
Wide Range ◽  
History Of ◽  
St Elevation

Abstract Background: Functioning paraganglioma is a rare catecholamine-producing tumor that arises in the sympathetic nervous system. It usually presents with sustained or paroxysmal hypertension accompanied by episodes of its classic triad of headache, palpitation, and diaphoresis. However, a wide range of signs and symptoms may be present. We report an unusual manifestation as acute myocardial infarction, which accidentally diagnosed by the trigger response from metoclopramide injection. Case presentation A 66-year-old woman with medical history of well-control hypertension, dyslipidemia and type 2 diabetes mellitus for 8 years presented with typical angina pain for 1 hour. She denied history of chest pain or triad symptoms of pheochromocytoma/paraganglioma (PCC/PGL). Her physical examination was unremarkable except severe hypertension, 206/89 mmHg, and occasional sinus tachycardia. Acute inferior wall myocardial infarction was proposed by an electrocardiogram study, acute ST elevation in lead II, III and aVF, and highly elevated cardiac enzymes. Echocardiogram and coronary angiography showed preserved left ventricle function (LV ejection fraction 70%) without regional wall motion abnormality. No evidence of coronary artery disease was found. During the catheterization, the cardiologist raised the possibility of the presence of PCC/PGL from her fluctuating blood pressure, 73/42 to 206/113 mmHg, after 10-mg metoclopramide injection to control her vomiting. Computer tomography of the abdomen showed a lobulated heterogeneous enhancing left para-aortic mass with internal necrosis, 6.1x4.9x4.1 cm in size, abutting left anterolateral aortic wall and encasing celiac trunk, superior mesenteric artery, and left renal arterial wall. Her hormonal study showed 24-hour urine fractionated metanephrine/normetanephrine levels of 2,924 nmol (<1,777 nmol)/4,328 nmoL(< 3,279 nmol), respectively, and plasma free metanephrine/normetanephrine levels of 93.66 pg/mL (0-96.6 pg/mL)/233.61 pg/mL (0-163.05 pg/mL). She underwent surgical tumor removal with uneventful outcome and the pathology confirmed the diagnosis of functioning PGL. During 2-years follow-up, the patient remained asymptomatic and her hormonal and functioning imaging study showed no recurrence. The genetic testing for PCC/PGL panel was negative. Conclusion: We present an unusual manifestation of PCC/PGL as acute coronary syndrome. The clinician should remind this tumor as the differential diagnosis, especially in a patient with negative coronary angiogram.

scholarly journals Assessment of arrhythmias in 50 patients of ST-elevation myocardial infarction after thrombolysis: a 24 hour Holter study

2017 ◽  
Vol 4 (3) ◽  
pp. 734 ◽  
Author(s):  
Rishi Rajhans ◽  
M. Narayanan
Keyword(s):  
Myocardial Infarction ◽  
Sinus Tachycardia ◽  
Anterior Wall ◽  
Warning Sign ◽  
Inferior Wall ◽  
Inclusion Criteria ◽  
Global Epidemic ◽  
Coronary Syndrome ◽  
Life Threatening ◽  
St Elevation

Background: Acute coronary syndrome represents a global epidemic. The purpose of this study was to evaluate the incidence of cardiac arrhythmias in acute myocardial infarction (AMI) in the first 24 hours of hospitalization post thrombolysis.Methods: 50 patients of AMI satisfying the inclusion criteria were included for this observational study. Philips Digitrak Holter was attached to the patient's chest for 24 hours and arrhythmias were noted.Results: In the study group 70% of cases were males, rest 30% females. Maximum incidence of AMI was seen between 4th and 7th decade of life. Incidence of diabetes and hypertension were 54% and 66% respectively either alone or in combination. Overall incidence of anterior wall was higher 56% than inferior wall which was 44%. Sinus tachycardia was seen in 54% of cases with higher incidence in anterior wall MI. Among the reperfusion arrhythmias incidence of frequent VPCs was highest with 66% followed by AIVR (42%) and NSVT (30%). AF was found in 3 cases i.e. 6% of which one died. One patient had VF to which she succumbed.Conclusions: It is a matter of debate whether arrhythmias being so common in AMI, should be considered under clinical spectrum or complication of AMI. An increasing belief that less serious arrhythmias may serve as a warning sign for potentially life threatening arrhythmias and timely intervention by drugs, D.C. shock or pacemakers can prevent mortality in these sets of patients.

Abstract 18710: Added Value of Electrocardiographic Signs and Symptoms to Improve Early Detection of Acute Coronary Syndrome in the Emergency Department

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jessica K Zègre-Hemsey ◽  
Larisa A Burke ◽  
Holli A DeVon
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Signs And Symptoms ◽  
Symptom Distress ◽  
St Elevation Myocardial Infarction ◽  
Specific Symptom ◽  
Arm Pain ◽  
Coronary Syndrome ◽  
Cardiac Symptoms ◽  
St Elevation

Background: Early identification and diagnosis are critical in the management of patients with acute coronary syndrome (ACS) since time-dependent therapies reduce patient mortality and morbidity. Objective: The aims of this study were to describe differences in presenting symptoms by individual ACS diagnoses and determine the prognostic value of both signs (electrocardiographic evidence of ischemia) and symptoms for an ACS diagnosis. Method: Patients > 21 years old, with any ECG ischemic changes (ST-elevation, ST-depression, T-wave inversion), elevated serum troponin, and ACS symptoms presenting to one of five emergency departments (ED) were eligible for the study. Patients completed the ACS Symptom Checklist, a validated 13-item instrument that measures cardiac symptoms (typical and atypical). Pearson Chi-square tests were used for bivariate analyses and logistic regression was used for multivariate modeling. Results: A total of 1,031 patients (mean age 60 + 14, 62% male, 70% White) were enrolled; 450 (43.7%) were diagnosed with ACS. One hundred eleven (11%) had ST-elevation myocardial infarction (STEMI), 236 (23%) had non-ST elevation myocardial infarction (NSTEMI), 103 (10%) had unstable angina (UA), and 581 (56%) were ruled-out for ACS. Patients with STEMI were more likely to report chest pain, diaphoresis, and higher symptom distress (p<0.05) at presentation than those without. Patients with NSTEMI were more likely to report arm pain and patients with UA were more likely to report lightheadedness (p<0.05). The presence of any chest symptoms (OR 2.24; 95% CI 1.27-3.97), higher symptom distress (OR 1.07; 95% CI 1.0-1.15), and a lower number of symptoms (OR 0.92; 95% CI 0.86-0.98) were independent predictors of an ACS diagnosis (p<0.05). The strongest predictor of an ACS diagnosis was the presence of ECG ischemic changes (OR 4.51, 95% CI 3.20-6.36) adjusting for symptoms, age, gender, heart rate, arrhythmia, and troponin levels (p<0.001). Conclusion: ECG signs of ischemia combined with specific symptom characteristics may enhance timely triage and detection of ACS in the ED. Predictive models that incorporate presenting signs and symptoms should be explored for this vulnerable population.

scholarly journals Acute Myocardial Infarction Caused by an Anomalous Right Coronary Artery Occlusion Presenting with Precordial ST Elevation

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Bruno da Silva Matte ◽  
Alexandre Damiani Azmus
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Sinus Node ◽  
Artery Occlusion ◽  
Inferior Wall ◽  
St Segment Elevation ◽  
Right Ventricular Infarction ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Ventricular Infarction

Acute coronary syndrome with precordial ST segment elevation is usually related to left anterior descending artery occlusion, although isolated right ventricular infarction has been described as a cause of ST elevation in V1–V3 leads. We present a case of a patient with previous inferior wall infarction and new acute ST elevation myocardial infarction (STEMI) due to proximal right coronary thrombotic occlusion resulting in right ventricular infarction with precordial ST elevation and sinus node dysfunction. The patient was treated with successful rescue angioplasty achieving resolution of acute symptoms and electrocardiographic abnormalities.

scholarly journals Epidemiology and risk factors of patients with types of acute coronary syndrome presenting to a tertiary care hospital in Sri Lanka

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Udaya Ralapanawa ◽  
Pallegoda Vithanage Ranjith Kumarasiri ◽  
Kushalee Poornima Jayawickreme ◽  
Prabashini Kumarihamy ◽  
Yapa Wijeratne ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Sri Lanka ◽  
Unstable Angina ◽  
Stable Angina ◽  
Strong Association ◽  
Coronary Syndrome ◽  
History Of ◽  
St Elevation

Abstract Background Acute Coronary Syndrome (ACS) is one of the leading causes of death worldwide and studies have shown higher mortality rates and premature death in South Asian countries. The occurrence and effect of risk factors differ by type ofACS.Epidemiological studies in the Sri Lankan population are limited. Methods This is a cross sectional descriptive study conducted at the Teaching Hospital Peradeniya, Sri Lanka among patients presenting with ACS. Data was collected by an interviewer administered structured questionnaire and epidemiological patterns and risk factors were analyzed. Results The sample of 300 patients had a mean age of 61.3+/− 12.6 and male sex showed higher association with all three type of ACS compared to female with a P value of 0.001. This study showed higher mean age of 62.2 ± 11.4 years amongst unstable angina (UA) patients and 61.9 ± 14.5 years amongst non ST elevation myocardial infarction (NSTEMI) patients compared to 59.2 ± 11.2 years for ST elevation myocardial infarction (STEMI) patients with no significant statistical difference (P = 0.246). Approximately 55.8% STEMI patients, 39.8% UA and 35.5% NSTEMI patients were smokers indicating a significant association between smoking and STEMI (P = 0.017). Nearly 54.5% STEMI, 35.4% UA and 32.7% NSTEMI patients consumed alcohol and there was a very strong association between alcohol consumption and STEMI (P = 0.006). Almost 51.8% NSTEMI patients, 47.8% UA patients and 29.9% STEMI patients had hypertension(HT) (P = 0.008) indicating significant association of HT with UA and NSTEMI. About 33.6% UA patients and 30.0% NSTEMI patients had DM whilst only 22.1% of STEMI patients had DM of no significance (p = 0.225). Around 15.0% patients with UA, 25.5% with NSTEMI and 11.7% with STEMI had dyslipidemia (P = 0.032). There was a very strong association between a past history of ACS or stable angina with NSTEMI and UA (P = 0.001). Conclusion Smoking and alcohol abuse are significantly associated with STEMI.Patients with NSTEMI or Unstable Angina had higher rates of hypertension and were more likely to have a history of ACS or stable angina than STEMI patients. Patients with NSTEMI were more likely than patients with STEMI or UA to have dyslipidemia.

scholarly journals Dengue fever complicated with acute ST elevation myocardial infarction - a therapeutic conundrum: our experience from two cases

2021 ◽  
Vol 12 (1) ◽  
pp. 118-123
Author(s):  
Maheshi Wijayabandara ◽  
Devasmitha Wijesundara ◽  
Champika Gamakaranage ◽  
Panduka Karunanayake ◽  
Shyam Fernando ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Dengue Fever ◽  
Clinical Manifestations ◽  
Dengue Shock Syndrome ◽  
Bleeding Risk ◽  
St Elevation Myocardial Infarction ◽  
Management Guidelines ◽  
Coronary Syndrome ◽  
Wide Range ◽  
St Elevation

Dengue fever has a wide range of clinical manifestations from asymptomatic disease to complicated dengue haemorrhagic fever and dengue shock syndrome. Bleeding manifestations in dengue is well known but thrombotic events complicating dengue is uncommon. ST elevation myocardial infarction during dengue is rare and poses important management dilemma. At present, there is no consensus on how to manage this situation. We present two patients with dengue fever developing ST elevation myocardial infarction and our experience in the management. We suggest case-based management of acute coronary syndrome in dengue, guided by the degree of thrombocytopaenia and bleeding risk. Further studies are needed to include this into existing dengue management guidelines.

scholarly journals In Hospital Outcome of Myocardial Infarcton in Nondiabetic Patients with High on Admission Blood Glucose Level

1970 ◽  
Vol 3 (2) ◽  
pp. 143-148
Author(s):  
M Ullah ◽  
LA Sayami ◽  
MR Khan ◽  
A Jahan ◽  
Z Rahman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Glucose ◽  
Blood Sugar ◽  
Blood Sugar Level ◽  
Diabetic Patients ◽  
Hospital Outcome ◽  
Coronary Syndrome ◽  
History Of ◽  
St Elevation ◽  
The Impact

Background: Patients without a history of diabetes often develop hyperglycemia during an acute coronary syndrome (ACS). Our aim was to evaluate the impact of admission hyperglycemia on in hospital outcome of non-diabetic patients admitted for acute coronary syndromes. Methods: The retrospective study was conducted in National Institute of Cardiovascular Diseases among the patients with acute myocardial infarction without history of diabetes. 50 patients with ST elevation MI (STEMI) with complications, 50 patients with STEMI without complications, 50 patients with non-ST elevation MI (NSTEMI) with complications and 50 patients without complications were included in the study. Every patient got the treatment as per protocol of the institute. On admission blood glucose of the patients was recorded. Level of blood glucose was correlated with the frequency of complications. Results : Average on admission blood sugar level was higher in patients who developed complications with STEMI (11.4 vs 8.78 mmol/L). On admission blood sugar level was also significantly higher in patients with NSTEMI with complications (10.6 vs 8.6 mmol/L). The frequency of individual complications had no significant relation with the blood sugar level. Conclusion : Higher level of admission blood glucose is related to poor in hospital outcome in both STEMI & NSTEMI even in nondiabetic patients. It may be used as a predictor of poor outcome of patients with myocardial infarction. Keywords: STEMI; NSTEMI; Blood glucose. DOI: http://dx.doi.org/10.3329/cardio.v3i2.9183 Cardiovasc. J. 2011; 3(2): 143-148

scholarly journals Predictors of Ambulance Transport in Patients with ST-Elevation Myocardial Infarction

2012 ◽  
Vol 27 (3) ◽  
pp. 226-230 ◽  
Author(s):  
Tara M. Scherer ◽  
Stephan Russ ◽  
Cathy A. Jenkins ◽  
Ian D. Jones ◽  
Corey M. Slovis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
St Elevation Myocardial Infarction ◽  
Cardiac Intervention ◽  
Awareness Campaigns ◽  
Coronary Syndrome ◽  
Private Vehicle ◽  
Ambulance Transport ◽  
History Of ◽  
St Elevation ◽  
Mode Of Transport

AbstractIntroductionDespite intense public awareness campaigns, many patients with ST-elevation myocardial infarction (STEMI) do not utilize Emergency Medical Services (EMS) transportation to the Emergency Department (ED). Predictors for mode of transport by EMS versus private vehicle in patients with an acute STEMI were investigated.HypothesisIt was hypothesized that patient characteristics, specifically older age, male sex, and a history of a prior cardiac intervention, would be associated with a higher likelihood of EMS utilization.MethodsA retrospective, observational cohort study was performed for all STEMI patients treated from April 1, 2007 through June 30, 2010 at an urban, academic ED with 24-hour cardiac catheterization available. Multivariable analyses with predetermined predictors (age, sex, prior cardiac intervention, weekend/evening arrival) were performed to investigate associations with mode of transport. Door-to-balloon (D2B) times were calculated.ResultsOf the 209 STEMI patients, 11 were excluded, leaving 198 for analysis. Median age was 60 years (IQR: 53-70), 138 (70%) arrived by private vehicle, and 60 (30%) by EMS. The primary analysis did not identify significant predictors for EMS, but a post-hoc model found that private insurance (OR 0.18; 95% CI, 0.07-0.45) was associated with fewer EMS transports. Although not statistically significant due to the great variability in time of arrival for STEMI patients transported by private vehicle, EMS transports had shorter D2B times. During business hours and weekend/evenings, EMS had D2B times of 50 (IQR: 42-61) and 58 minutes (IQR: 47-63), respectively, while private vehicle transports had median D2B times of 62 (IQR: 50-74) and 78 minutes (IQR: 66-106).ConclusionNo associations between mode of transport and patient age, sex, weekend/evening presentation and history of a prior cardiac intervention were identified. Privately insured patients were less likely to use EMS when experiencing a STEMI. More effective ways are needed to educate the public on the importance of EMS activation when one is concerned for acute coronary syndrome.Scherer TM, Russ S, Jenkins CA, Jones ID, Slovis CM, Cunningham BL, Barrett TW. Predictors of ambulance transport in patients with ST-elevation myocardial infarction. Prehosp Disaster Med. 2012;27(3):1-5.

scholarly journals How to Manage a Patient with Haemophilia and ACS Requiring PCI: A Battle between Bleeding and Thrombosis

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 352
Author(s):  
Konstantinos C. Theodoropoulos ◽  
Sofia Vakalopoulou ◽  
Maria Oikonomou ◽  
George Stavropoulos ◽  
Antonios Ziakas ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Intervention ◽  
Management Plan ◽  
Clotting Factor ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
History Of ◽  
St Elevation

We present the case of a 70-year-old man with a history of haemophilia B, who presented to our hospital with a non-ST-elevation myocardial infarction. The patient, following consultation by a haemophilia expert, was revascularized with percutaneous coronary intervention (PCI) under adequate clotting factor administration. Patients with haemophilia and acute coronary syndrome, are susceptible to periprocedural bleeding and thrombotic events during PCI, and therefore a balanced management plan should always be implemented by a multidisciplinary team.

scholarly journals Dead man sign of ECG: An unique predicting sign of acute coronary syndrome

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Troponin I ◽  
Inferior Wall ◽  
Excessive Sweating ◽  
Common Cause ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Artery Disease ◽  
Dead Man

Coronary artery disease is the most common cause of morbidity and mortality worldwide. Acute coronary syndrome which includes STEMI, NSTEMI and unstable angina commonly diagnosed with the help of 12 lead in ECG in ER with or without elevated biomarkers. Inferior wall myocardial infarction is common cause of ST elevation myocardial infarction with low mortality rate. In this case report, we present a 52 years old male presented to ER with the complain of typical chest pain for more than 2 hours duration. Pain was in center of chest with radiation to back and left arm and associated with excessive sweating. Patient is a known smoker for past 10 years. At presentation Blood pressure was 110/70 mmHg and pulse rate of 55/min. Troponin I level was five times of upper normal limit. Basic investigations including ECG were done at presentation. ECG was showing typical changes of inferior wall myocardial infarction with infarction of right ventricle with hidden unique sign known as dead man sign commonly predict the location of obstruction and course of disease in the setting of acute coronary syndrome.

Cardiac surgery

2016 ◽  
Author(s):  
Maria Kisiel ◽  
Alison Smith
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
St Elevation Myocardial Infarction ◽  
Surgical Interventions ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Artery Disease

Coronary heart disease is caused by the build-up of atherosclerotic plaques which, over time, narrow the lumen of the coronary arteries. Acute coronary syndrome describes a spectrum of conditions caused by coronary artery disease; these are unstable angina, ST-elevation myocardial infarction (STEMI), and non-ST-elevation myocardial infarction (NSTEMI). Coronary artery disease is the leading cause for cardiac surgical interventions, but other causes are hypertension, valve disease, arrhythmias, cardiomyopathies, infections, and congenital abnormalities. This chapter provides an overview of the signs and symptoms of these conditions, as well as the diagnosis and treatment options available.

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